HIV/AIDS Skepticism

Pointing to evidence that HIV is not the necessary and sufficient cause of AIDS

Posts Tagged ‘Treatment Action Campaign’

What’s next for the HIV/AIDS vigilantes at Treatment Action Campaign?

Posted by Henry Bauer on 2012/02/14

Just a couple of months ago, I noted that the Treatment Action Campaign in South Africa had urged the Gates Foundation not to proceed with trials comparing stavudine to tenofovir because stavudine is so much more toxic and should simply be replaced by tenofovir forthwith. I noted too how strange this seemed, given that the toxicity of tenofovir is high and well known, as I had noted in several posts; see “HAART is toxic: Mainstream concedes it, in backhanded ways” (2011/12/30).
What will TAC do next, given that the toxicity of tenofovir is becoming talked about increasingly?


“In their analysis of comprehensive VA electronic health records, the study authors found that for each year of exposure to tenofovir, risk of protein in urine — a marker of kidney damage — rose 34 percent, risk of rapid decline in kidney function rose 11 percent and risk of developing chronic kidney disease (CKD) rose 33 percent. The risks remained after the researchers controlled for other kidney disease risk factors such as age, race, diabetes, hypertension, smoking and HIV-related factors. . . . Patients were tracked for an average of 1.2 years after they stopped taking tenofovir. They remained at elevated risk for at least six months to one year compared with those who never took the drug, suggesting that the damage is not quickly reversible . . . . ‘We do not know the long-term prognosis for these patients who stop tenofovir after developing kidney disease’”.
(Of course the authors of the reported study pointed out that HIV itself increases the risk of kidney damage. HIV itself is blamed by HIV/AIDS believers for every ill that antiretroviral drugs bring, for example “HIV-associated lipodystrophy”. Strange that all this supposed harm done by “HIV” was first noted only after antiretroviral drugs came into use.)

I confess that my query, what’s next for TAC, is replete with unashamed and undisguisable Schadenfreude.
The Treatment Action Campaign (TAC) in South Africa exemplifies as actively virulent a set of HIV/AIDS groupies and vigilantes as one could find anywhere. It is not too easy, though, to find out who exactly are the individuals who staff TAC. The website identifies only the “Leadership” of Vuyiseka Dubula, TAC General Secretary, and Nonkosi Khumalo, TAC Chairperson; and the Contact page gives the name only of the PR person (“Media Comment”), Caroline Nenguke. In this type of organization, these positions are figureheads, the real work being done by full-time staff.
The Annual Report for 2010 like the website gives no names of staff, not even who wrote the Report. It does mention — as had earlier news items — that funding has declined in a way that has made it necessary to retrench. Were I a donor, I would be unhappy at the Annual Report’s acknowledgement that the budget shows “General and Administrative” expenses at 21.7 million, not much below what was spent on “Programmes and Projects” at 27.6 million (currency is not indicated, presumably SA Rand). However, the Report does give a link  for the full financial reports, and the 2011 one has the names of 5 directors: NAC Khumola, V Dubula-Majola, N Geffen, MJ Heywood, and TT Diamini, as well as two who had resigned in 2010: A Achmat and TGP Klaas. Compensation for the 5 directors is shown as 777,019 (if in South African Rand, a bit over US$100,000), a very small part of the 21,700,000  “General and Administrative” expenses. What were the other parts?
Nathan Geffen is a member of “AIDStruth.org”, co-authored Edwin Cameron’s book, “Witness to AIDS”, and himself has written “Debunking Delusions: The Inside Story of the Treatment Action Campaign” (2010). He is active not only in HIV/AIDS matters but also politically, active among Jews who are critical of Israeli policies and actions. Mark Heywood is Director of the AIDS Law Project, whose website is as lacking in individuals’ names as is the TAC website.
I am irrevocably suspicious of organizations that do not give up front the names of all their significant staff and that do not in public documents itemize expenditures on salaries and associated benefits, just as I’m not interested in the views of bloggers and commenters who hide their identities. When things are not revealed, it seems reasonable to infer that revealing those things would discredit whoever wants them to remain hidden.

Posted in antiretroviral drugs, Funds for HIV/AIDS | Tagged: , | 4 Comments »

HAART is toxic: Mainstream concedes it, in backhanded ways

Posted by Henry Bauer on 2011/12/30

Just as it’s rare to find “HIV” mentioned without the add-on of “AIDS” or “the virus that causes AIDS”, so it’s rare to see antiretroviral drugs mentioned without the adjective “life-saving”. Yet the technical mainstream literature is replete with backhanded admissions that antiretroviral drugs are highly toxic.
What do I mean by backhanded? Making the admission in such a way that it seems like not an admission.
For example, in what the Journal of Infectious Diseases  labeled a “Major Article”, Walensky et al. calculated “The survival benefits of AIDS treatment in the United States” (194 [2006] 11-19) without claiming any survival benefit for the use of AZT from its introduction up to its approval in 1994 for prevention of mother-to-child transmission. Yet when mainstream researchers are confronted with dissident statements about the lack of life-saving benefit of AZT and its toxicity, they resist ferociously by every conceivable evasive maneuver.

I’ve just come across another choice example of admitting in one context what in other contexts is not admitted. The activist gurus of the Treatment Action Campaign (TAC) have long castigated President Mbeki and others for not providing the life-saving benefits of antiretroviral drugs to South Africans. But now the very same self-appointed experts, in collaboration with Médecins Sans Frontières (MSF) have asked the Gates Foundation  not to support a clinical trial in which the relative benefits of tenofovir are to be compared with stavudine at 20 mg dosage — because stavudine is so toxic!
Mbeki was President of South Africa from 1999 to 2008. Had he bowed to TAC activists, he would have been providing this highly toxic stavudine to his fellow country-people, because stavudine has been one of the staples of antiretroviral treatment since the mid-1990s. It was approved for adults in the middle of 1994, and for children in the latter part of 1996. In 1998 it was recommended for antiretroviral treatment at dosage of  40 mg for body weights > 60 kg and 30 mg for <60 kg (MMWR 47, RR-5, 24 April). The Treatment Guidelines issued by the National Institutes of Health have sanctioned use of stavudine as first-line or alternative ever since, despite the pleas by the World Health Organization cited  in the TAC/MSF letter to the Gates Foundation.
The letter says, “In 2004, stavudine was removed from the list of preferred first-line antiretroviral drugs recommended by the US Department of Health and Human Services”. That might mislead unwary readers into thinking that stavudine had been removed from all recommended uses, whereas in fact it continues to be listed in the Treatment Guidelines as an available alternative. Thus the Guidelines of 1 December 2009 include the following:
“The 2NN trial compared efavirenz and nevirapine, both given with stavudine and lamivudine, in treatment-naïve  patients. Virologic responses were similar for both drugs, although nevirapine was associated with greater toxicity and  did not meet criteria for noninferiority compared with efavirenz”, illustrating that stavudine was by no means regarded as beyond the pale.
Note too the mention of toxicity of nevirapine. Dissidents have long protested the use of nevirapine and AZT as the standard procedure recommended to avoid mother-to-child prevention of transmission of “HIV”, whereas vigilantes like the TAC gurus have consistently supported these uses of these drugs — see for example “Nevirapine, TB, and HIV/AIDS”  and “Nevirapine — P.S.”
Of course the Treatment Guidelines do acknowledge the toxicity of stavudine:

— at least in combination with lamivudine. But “Not recommended as initial therapy [emphasis added]” is not at all the same as “Should not be used”.
The 2009 Guidelines also warn that “combined use of didanosine and stavudine as a dual-NRTI backbone can result in a  high incidence of toxicities, particularly peripheral neuropathy, pancreatitis, and lactic acidosis . . . . This  combination has been implicated in several deaths of HIV-infected pregnant women secondary to severe lactic acidosis  with or without hepatic steatosis and pancreatitis . . . . Therefore, the combined use of didanosine and stavudine is not recommended”. Again, “not recommended” is not synonymous with “should not be used”.
Furthermore, “NRTI Substitutions (e.g., changing from zidovudine or stavudine to tenofovir or abacavir): This may be considered for a patient who has no history of viral resistance on an NRTI-containing regimen” (p. 74) illustrates that both zidovudine (= AZT) and stavudine continued, in 2009, to be standard components of antiretroviral cocktails.
Beyond that, the dangerous combination of didanosine and stavudine continues to be recommended as a possible last resort:


or if patients already have renal or hepatic insufficiency (= kidney or liver disease):


Perhaps the reasoning is that they’re dying anyway, maybe the stavudine will help them along?

So by 2009 there were certain caveats to the use of stavudine, by contrast to the “strong recommendations” for its use in earlier years, even in the deadly combination with didanosine:
In February 2001, the Treatment Guidelines “strongly recommended” stavudine “for initial treatment of established HIV infection”, in combination with “didanosine or lamivudine plus efavirenz or indinavir”.
Again in July 2003, The “Recommended Combination  Antiretroviral Regimens” included  “Efavirenz + (zidovudine or tenofovir or stavudine)  + lamivudine as preferred initial NNRTI-based  regimens (except for pregnant women)”.
In  October 2005, it was downgraded to ordinary, not strongly recommended:
“NNRTI-Based Regimens —  Efavirenz + (didanosine or abacavir or stavudine) + (lamivudine or emtricitabine) (except during pregnancy, particularly the first trimester, or in women  with high pregnancy potential)”. However, it was still lauded for efficacy: “The most experience with efavirenz, demonstrating  good virologic responses, has been shown in  combination with 2-NRTI backbones of lamivudine plus zidovudine, tenofovir, stavudine, abacavir, or  didanosine”. “Alternative PI-based regimens may include: . . . all used in  combination with zidovudine or stavudine or  tenofovir . . .”.
For “Selection of Dual Nucleoside ‘Backbone’  as Part of Initial Combination Therapy” the recommendation was “(Zidovudine or tenofovir) + (lamivudine or emtricitabine) as the 2-NRTI backbone of choice  as part of some combination regimens. . . . (Stavudine or didanosine or abacavir) + (lamivudine or emtricitabine) may be used as  alternative 2-NRTI backbone combinations”.
“It may be necessary to prescribe alternative NRTIs for some patients because of side effects of these agents, such as bone marrow  suppression with zidovudine and the increasingly reported toxicities including lipoatrophy and  symptomatic lactic acidosis with stavudine”.
A backhanded admission that AZT/ZDV suppresses the bone marrow — an admission that was not made, of course, when Duesberg said it and pointed out that this kills the immune system, so that the drugs produce the very disease they are supposed to treat.
Given the acknowledged toxicities, why are antiretroviral drugs continuing to be administered?
Because of  their supposed effectiveness — effective in lowering “viral load”, that is: “Both the tenofovir + lamivudine combination and stavudine + lamivudine combination  are highly and durably effective when used in  combination with efavirenz, with data up to 144 weeks . . . .  In this study, patients randomized to the stavudine + lamivudine arm experienced more adverse effects including peripheral neuropathy and  hyperlipidemia”.  “The combined use of didanosine and stavudine as a 2-NRTI backbone can  result in a high incidence of toxicities, particularly peripheral neuropathy, pancreatitis, and lactic acidosis . . . .This combination has been implicated in  several deaths in HIV-1 infected pregnant women  secondary to severe lactic acidosis with or without hepatic steatosis and pancreatitis . . . . In general, a  combination containing didanosine and stavudine should be avoided unless other 2-NRTI combinations have failed or have caused unacceptable toxicities, and where potential benefits outweigh the risks of toxicities”.
“Avoided unless” once again falls far short of condemning the use.
Evidently the “operation” is a success if it kills “HIV”, even if the patient also dies in the process.
Note the shameless evasion or disclaiming of responsibility in weasel-expressions like “where potential benefits outweigh the risks of toxicities”. How might one practice that? By spelling out what the risks actually are and what the benefits are supposed to be — what are the odds ratios? For absolute risk and absolute benefit? Does anyone do that for patients?
Note too that “not recommended” is the Treatment Guidelines’ backhanded way of acknowledging dangerous toxicity. Stavudine went from “strongly recommended” merely to “not recommended” and “alternative” when other things don’t seem to work. Yet the TAC/MSF letter cites copious evidence that stavudine is so toxic that it shouldn’t be used even at half the original dosage, even in a clinical trial where incipient adverse events would be closely monitored. That’s because “For good reason, tenofovir has become the gold standard for today’s first-line antiretroviral  therapy”.
That surprised me, since I had blogged about the toxicity of tenofovir already 4 years ago: “To avoid HIV later, damage your kidneys and liver now”; “Tenofovir and the ethics of clinical trials”; “Kidney-disease denialism (a special case of HAART denialism)”: “increasing exposure to tenofovir was associated with a higher incidence of CKD [chronic kidney disease] . . . . Nephrolithiasis was seen in up to 27% of patients treated with indinavir . . . and there are numerous studies . . . demonstrating that tenofovir is associated with impaired kidney function”.

Not that I claim to have discovered the toxicity of tenofovir — it’s noted in government sources:


as well as by the manufacturers:


To summarize:
Stavudine was highly recommended for antiretroviral treatment for about a decade and is still in use, though it was soon found to be so toxic that TAC/MSF describes it as unacceptably toxic — by comparison to tenofovir, which has been known for years to cause serious liver damage  and lactic acidosis, both potentially fatal. But then, as noted in the manufacturer’s warning above, these toxicities are associated with all nucleoside analogues (NRTIs).

How many people were killed or maimed by stavudine during the decade or so when it was strongly recommended and used routinely?

TAC/MSF are correct: “There is therefore no good reason why a properly  informed patient should want to enrol in this study” [of tenofovir vs. 20 mg stavudine]. But they ought to have made that more general:

A properly informed “HIV-positive” patient
would refuse antiretroviral drugs altogether.

The TAC/MSF letter stretches over 4 pages and is a cornucopia of other deficiencies. To support their claim of tenofovir’s superiority, for instance, they cite an article just published “ahead of print” — when anyone who understands science knows that no just-published claim is to be taken seriously until others have confirmed it. The letter refers to the “Serious adverse event” of mitochondrial toxicity, without acknowledging that this serious adverse event is characteristic of ALL antiretroviral drugs. That’s been known for a long time: “Hidden in plain sight: The damage done by antiretroviral drugs”.

I’m left with a curiosity about the social psychology of all this. What could stimulate this group of people to compose so pompous and unwieldy a petition whose only purpose is to give preference to one highly toxic drug over another highly toxic drug?
I think this illustrates how addled brains become when they have been so indoctrinated as to lose the ability to weigh the actual evidence.
Or, as I’ve mused before, behold what cognitive dissonance does to true believers.

Posted in antiretroviral drugs, clinical trials, experts, Legal aspects | Tagged: , , , | 20 Comments »

Grabbing a monster by the tail

Posted by Henry Bauer on 2010/02/02

The monster is HIV/AIDS. The thoughtless action has been to wage ceaseless propaganda that everyone should be tested, even as a positive test is said to mean stigma, lifelong disability, and an early death. Some consequences are coming home to roost in South Africa:

“The national health department and the Treatment Action Campaign (TAC) have added their voices to condemning the use of HIV home testing kits, saying they are risky to use at home and their accuracy cannot be guaranteed. This follows a warning from the SA Medical Association (Sama), which cautioned that home testing for HIV could leave people devastated. . . . TAC general secretary Vuyiseka Dubula warned against the use of the kits. Suicides could result if people tested at home and got a positive result. . . . ‘When doing an HIV test it’s very important to know why you are doing it, and to have a proper support system’” (“South Africa: HIV Home Tests – More Warnings”).
Doesn’t it seem rather odd, that someone who keeps urging everyone to get tested then implies or insists that they need some other reason for being tested than that everyone is being urged to get tested?
Perhaps there’s a subliminal awareness that the tests are often misleading?

“Dubula also questioned the accuracy of home testing kits, saying there was no confirmation.  ‘All HIV tests must be confirmed. The worry with self-testing is that it’s not always possible to confirm the results. Some people may not be able to afford to buy a second kit to confirm their results,’ she said, urging people to get free tests at public health facilities.”
But there’s no such thing as a confirming HIV test, according to  “Laboratory detection of human retroviral infection” by Stanley H. Weiss and Elliott P. Cowan, Chapter 8 in AIDS and Other Manifestations of HIV Infection, ed. Gary P. Wormser, 4th ed. (2004). None of the tests are capable of establishing the presence of HIV infection; all results should be expressed as probabilities; so-called “confirmatory” tests are actually only supplemental tests, to be used only as additional adjuncts to clinical observation and medical histories. “Each individual assay has its own associated special characteristics and is not interchangeable with other assays, even within a given class of test” (p. 148). “In the absence of gold standards, the true sensitivity and specificity for the detection of HIV antibodies remain somewhat imprecise” (p. 150).
The truly monstrous fact is that the public hears constantly about confirmatory tests and the 99%+ sensitivity and specificity of HIV testing at the same time as the expert technical literature emphasizes that such a high “accuracy” still means that in low-risk groups the probability of false positives may be 5 out of 6 and that no test or sequence of tests can prove infection (“’HIV’ tests are self-fulfilling prophecies”, 10 May 2009).

When public policies are based on ignorance, this is the sort of mess that ensues. On the one hand, the policy makers are told that “rapid testing may assist in facilitating the diagnosis of HIV infection, improving HIV testing capabilities in facilities without access to laboratories”; on the other hand it’s recognized that “There was also the danger of misinterpretation of the results of the home test kit . . . . Professor Peter Eagles, chairman of the Medical Control Council . . . said consumers needed to ensure the product was of a good quality, and registered in its country of origin.”
How, one might logically ask, should the typical “consumer” in Africa distinguish advertisements by makers of the home-test kits from other propaganda they are subjected to? But perhaps above all, consider the implications of the assertion that “rapid testing”, notoriously unreliable in itself, can assist with “diagnosis of HIV infection”, when Weiss & Cowan go to great pains to describe the lengthy, elaborate procedures required to diagnose infection in ways that do not rely exclusively on test results.

There is a similar disconnect between the incessant propaganda to distribute antiretroviral drugs in Africa and the considered views of the treatment experts that antiretroviral treatment requires constant careful monitoring, frequent laboratory testing, the likelihood of needing to change treatments at intervals, the elaborate procedures like “resistance testing” to choose the right treatment regimens in the first place:
” Multiple studies have demonstrated that better outcomes are achieved in HIV-infected outpatients cared for by a  clinician with HIV expertise [1-6], which reflects the complexity of HIV infection and its treatment. Thus, appropriate  training and experience, as well as ongoing continuing medical education (CME), are important components for  optimal care. Primary care providers without HIV experience, such as those who provide service in rural or  underserved areas, should identify experts in the region who will provide consultation when needed” (NIH Treatment Guidelines, 1 December 2009, p. 3).

It seems more than likely that good nutrition and vitamins and mineral supplements would do far more good in Africa than the liberal distribution of toxic antiretroviral drugs in absence of nearly enough experienced physicians to ensure that treatment is changed or discontinued at the first sign of toxic side-effects.

Posted in Alternative AIDS treatments, antiretroviral drugs, experts, HIV skepticism, HIV tests | Tagged: , , , , | 31 Comments »

 
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